A conversation about smart-device use among resident physicians

Smartphone ownership among U.S. health-care professionals has grown from 81 percent in 2010 to 91 percent in 2012. To gain a better understanding of how mobile phones and computer tablets are being used by these professionals, several Stanford researchers – Olufisayo Ositelu, an MD/MBA joint-degree candidate; Bassam Kadry, MD, an anesthesia instructor; Joshua Landy, MD, a visiting scholar; and Alex Macario, MD, an anesthesia professor – launched a study to measure the prevalence and types of uses of smart devices among resident physicians at Stanford Hospital & Clinics.

The study, which involved residents from across seven different specialties, revealed that participants’ top two uses were communications, such as exchanging patient care-related text messages, and obtaining pharmacy or medication-related information. Other common uses were: medical reference, textbook or study aid; obtaining information on evidence-based medicine and treatment algorithms; and keeping up with medical literature.

Interested to know more about the research, I contacted Ositelu to discuss his motivation for examining this area and to get his thoughts on the significance of the findings. He responds to my questions below.

What was the catalyst for completing this study?

As a medical student on clinical rotations, I noticed a great number of physicians using smart devices, including Apple and Android phones and tablets, for a wide range of health-care delivery activities. Interestingly, different specialties, such as internal medicine versus pediatrics, seemed to use their smart devices for different clinical purposes. These observations coupled with the numerous literature on high smart-device ownership among physicians led our team to realize smart devices were changing health-care delivery and had important implications for patient care. We set out to quantify smart-device ownership among Stanford hospital residents and get a snapshot of the activities performed on them. We chose resident physicians (trainees) as the focus of our study because the cohort has come of age using these technologies and [because] they represent the future of patient care.

What findings did you find most surprising?

One of the goals of this study was to find out if there really were inter-specialty differences in smart-device usage. We were able to demonstrate this. For example, the percentage of pediatrics residents that reported using their smart devices to obtain pharmacy/medication information “very frequently” was higher than that of anesthesia and internal medicine residents.

Residents want user-friendly electronic medical records (EMR) access on their smart devices. Given the mobile nature of patient care and the need to have the right information at the right time and place, this is not necessarily surprising. However, our study showed the use of smart devices by residents to view electronic medical records (EMR) was low across all specialties. It is unclear whether this was due to a lack of awareness about the existence of the EMR application or the cumbersome nature, such as too many logins, of the current offering. Additionally, the study revealed important insights on possible ways to leverage EMR functionalities on smart phones and tablets. For example, some residents wanted the ability to put in “basic patient orders” and get push notification or retrieval of patients’ lab values in real-time on their smart devices. It is worthwhile to note that a majority of these devices are personal devices, which means they were purchased by residents not Stanford hospital. It is surprising that residents did not express wanting a separation of personal and professional use of the smart devices. This fact has important implications for patient privacy and device security.

What unmet needs related to physician use of mobile devices did the study identify?

The unmet needs can be divided into two categories: patient-focused and resident physician-focused. Patient education ranked as one of biggest unmet patient-focused needs. The ability to engage patients in their care by providing high-quality, easy-to-understand education at the point of care is a central tenet of patient-centeredness. Residents reported needing “more patient-education apps” and the capability to “draw diagrams for patients in real time and possibly annotate preloaded diagrams.” Interestingly, the use of smart devices in the presence of patients raised concerns about perceived professionalism. Smart-device use could cause patients to believe physicians are distracted, not fully engaged in their care.

With respect to resident physicians, the biggest unmet need is the provision of easy-to-use, intuitive EMRs on their respective smart devices. According to residents, the current offering is somewhat cumbersome because they require multiple logins and are not amenable to the fast-paced environment of patient care. They also wanted more institutional support with respect to reliable wireless coverage and faster Internet speed. Residents appeared to hone in on patient rounds as a focal point for the improvement of EMR experience and functionality. They want to ability to look up patient information and place orders during patient rounds. One resident commented, “ I wish it was easier to get access to EPIC and other EMRs. The process is daunting and seems to take forever.”

How might this research help inform appropriate content and application development for health-care providers?

A big take-away from this study is that different specialties have different content and application needs. For example, neurologists may value secure photo or video application to document and share movement disorders with the treatment team; surgeons may value interactive anatomical diagrams to educate patients about procedures or surgeries; and internists may value access to high-quality evidence-based medicine resources.

More importantly, this study obtains the perspectives of the residents, giving a voice to the health-care professionals that are on the front lines of patient care. This research helps articulate how smart devices may be changing health-care delivery models, how they might integrate into physician workflow and how they may serve as potential levers for increased efficiency and quality of patient care.

The bigger issue with the high prevalence of smart devices may be the need for comprehensive hospital policy and infrastructure guiding and supporting their usage. As the lines between personal and professional use of these smart devices become increasingly blurred, there should be increasing focus on a hospital “mobility strategy” that ensures privacy and security. At the time of this study, it appears the default was the “bring-your-own-device” (BYOD) policy, not hospital-issued smart devices.

What further research is needed to better understand how physician use mobile devices for specific care-related tasks?

Our study has limitations due to our relatively small sample size (78 residents) and possible responder bias. For future research, medical and surgical departments could survey their respective residents to investigate their usage of these devices. Further research could also focus on measuring the impact of smart devices on specific outcomes related to physician efficiency and quality of care of patient care.